Preliminary Report of Validity for the Infant Comprehensive Evaluation for Neurodevelopmental Delay, a Newly Developed Inventory for Children Aged 12 to 71 Months

Objectives@#Early detection of developmental issues in infants and necessary intervention are important. To identify the comorbid conditions, a comprehensive evaluation is required. The study’s objectives were to 1) generate scale items by identifying and eliciting concepts relevant to young children (12–71 months) with developmental delays, 2) develop a comprehensive screening tool for developmental delay and comorbid conditions, and 3) assess the tool’s validity and cut-off. @*Methods@#Multidisciplinary experts devised the “Infant Comprehensive Evaluation for Neurodevelopmental Delay (ICEND),” an assessment method that comes in two versions depending on the age of the child: 12–36 months and 37–71 months, through monthly seminars and focused group interviews. The ICEND is composed of three parts: risk factors, resilience factors, and clinical scales. In parts 1 and 2, there were 41 caretakers responded to the questionnaires. Part 3 involved clinicians evaluating ten subscales using 98 and 114 questionnaires for younger and older versions, respectively. The Child Behavior Checklist, Strengths and Difficulties Questionnaire, Infant-Toddler Social Emotional Assessment, and Korean Developmental Screening Test for Infants and Children were employed to analyze concurrent validity with the ICEND. The analyses were performed on both typical and high-risk infants to identify concurrent validity, reliability, and cut-off scores. @*Results@#A total of 296 people participated in the study, with 57 of them being high-risk (19.2%). The Cronbach’s alpha was positive (0.533–0.928). In the majority of domains, the ICEND demonstrated a fair discriminatory ability, with a sensitivity of 0.5–0.7 and specificity 0.7–0.9. @*Conclusion@#The ICEND is reliable and valid, indicating its potential as an auxiliary tool for assessing neurodevelopmental delay and comorbid conditions in children aged 12–36 months and 37–71 months.

Bilateral cleft lip repair by new trending method: a case report / 대한악안면성형재건외과학회지

Background@#Bilateral cleft lip repair is one of the most difficult surgeries, and many techniques have been modified and developed to improve surgical outcomes. The current trend is toward preserving tissue as much as possible. When the reconstruction is based on the shape of the patient’s own tissue, the most natural appearance is produced, and the relaxed remaining tissue can be benefitted from reducing tension and minimizing scarring.Case presentation.In the conventional surgical method, the rest of the prolabium is sacrificed, except for the tissue used to make the philtrum. We used all tissues for surgery and did not discard any. The tubercle of the median vermilion was used in its original form. @*Conclusions@#It is fundamental to restore function in cleft lip surgery. Both patients and surgeons have a desire for esthetic outcomes that go beyond function. In addition, the measure of the success of the surgery is the postoperative resemblance to normal midfacial features. Unlike the conventional method of making tubercles by collecting lateral vermilion flaps, we preserved the tissue of the prolabium. Rather than using an artificial tubercle, we were able to create a more natural shape of the upper lip using the patient’s own anatomical structure. In addition, the remaining tissues of the discarded prolabium were used to make the oral mucosa, which may help to reduce tension compared to the conventional method. The modified repair method is expected to gradually become the mainstream method owing to its superior esthetic outcome and less surgical difficulty compared with traditional methods.

Diesel Exhaust Particles Impair Therapeutic Effect of Human Wharton’s Jelly-Derived Mesenchymal Stem Cells against Experimental Colitis through ROS/ERK/cFos Signaling Pathway

Background and Objectives@#Epidemiological investigations have shown positive correlations between increased diesel exhaust particles (DEP) in ambient air and adverse health outcomes. DEP are the major constituent of particulate atmospheric pollution and have been shown to induce proinflammatory responses both in the lung and systemically. Here, we report the effects of DEP exposure on the properties of human Wharton’s jelly-derived mesenchymal stem cells (WJ-MSCs), including stemness, regeneration, and immunomodulation. @*Methods@#and Results: Non-apoptotic concentrations of DEP (10 μg/ml) inhibited the migration and osteogenic differentiation capacity of WJ-MSCs. Gene expression profiling showed that DEP increased intracellular reactive oxygen species (ROS) and expression of pro-inflammatory and metabolic-process-related genes including cFos. Furthermore, WJ-MSCs cultured with DEP showed impaired suppression of T cell proliferation that was reversed by inhibition of ROS or knockdown of cFos. ERK inhibition assay revealed that DEP-induced ROS regulated cFos through activation of ERK but not NF-κB signaling. Overall, low concentrations of DEP (10 μg/ml) significantly suppressed the stemness and immunomodulatory properties of WJ-MSCs through ROS/ERK/cFos signaling pathways. Furthermore, WJ-MSCs cultured with DEP impaired the therapeutic effect of WJ-MSCs in experimental colitis mice, but was partly reversed by inhibition of ROS. @*Conclusions@#Taken together, these results indicate that exposure to DEP enhances the expression of pro-inflammatory cytokines and immune responses through a mechanism involving the ROS/ERK/cFos pathway in WJ-MSCs, and that DEP-induced ROS damage impairs the therapeutic effect of WJ-MSCs in colitis. Our results suggest that modulation of ROS/ERK/cFos signaling pathways in WJ-MSCs might be a novel therapeutic strategy for DEP-induced diseases.

Treatment of intramuscular lipoma of tongue with enveloped mucosal flap design: a case report and review of the literature / 대한악안면성형재건외과학회지

Background@#Lipomas are benign soft tissue neoplasms of mature adipose tissue commonly occurring in the trunk or extremities. But, intraoral lipomas are rare entities which may be only noticed during routine dental examinations. Especially intramuscular lipomas on the tongue have been reported very rarely. In this study, we report a case of intramuscular lipoma on tongue, with a review of the literature from 1978 to 2019, providing data on age, gender, location, presenting symptoms, size, surgical methods, and recurrence.Case presentationA case of intramuscular lipoma occurring in tongue region in a 65-year-old male is reported. Surgical excision is the mainstay of treatment for the lesion. In order to decrease the deformity and discomfort after the excision, we tried to modify surgical technique using enveloped mucosal flap. This technique provided more comfortable healing procedure on the operative site without recurrence. @*Conclusion@#This is a rare case of large intramuscular lipoma on tongue. Surgical excision with enveloped mucosal flap design was performed to diminish postoperative raw surface and discomfort and a 24-month follow-up showed excellent healing without any recurrence. A case of intramuscular lipoma on tongue and relevant literature reviews are presented in this study.

Treatment of intramuscular lipoma of tongue with enveloped mucosal flap design: a case report and review of the literature / 대한악안면성형재건외과학회지

Background@#Lipomas are benign soft tissue neoplasms of mature adipose tissue commonly occurring in the trunk or extremities. But, intraoral lipomas are rare entities which may be only noticed during routine dental examinations. Especially intramuscular lipomas on the tongue have been reported very rarely. In this study, we report a case of intramuscular lipoma on tongue, with a review of the literature from 1978 to 2019, providing data on age, gender, location, presenting symptoms, size, surgical methods, and recurrence.Case presentationA case of intramuscular lipoma occurring in tongue region in a 65-year-old male is reported. Surgical excision is the mainstay of treatment for the lesion. In order to decrease the deformity and discomfort after the excision, we tried to modify surgical technique using enveloped mucosal flap. This technique provided more comfortable healing procedure on the operative site without recurrence. @*Conclusion@#This is a rare case of large intramuscular lipoma on tongue. Surgical excision with enveloped mucosal flap design was performed to diminish postoperative raw surface and discomfort and a 24-month follow-up showed excellent healing without any recurrence. A case of intramuscular lipoma on tongue and relevant literature reviews are presented in this study.

Pituitary magnetic resonance imaging abnormalities in young female patients with hypogonadotropic hypogonadism

OBJECTIVE: To elucidate the association between clinical and laboratory characteristics and pituitary magnetic resonance imaging (MRI) abnormalities in young female patients with hypogonadotropic hypogonadism (HH). METHODS: We retrospectively investigated a series of 74 female patients (age range, 14–42 years) with normoprolactinemic HH who underwent pituitary MRI. Pubertal milestones and hormonal features of patients with small pituitary glands (PGs) and space-occupying lesions were compared with those of patients with normal PGs. RESULTS: The overall frequency of abnormal PGs was 35.1%, with space-occupying lesions observed in 8 patients (10.8%), and small PG observed in 18 patients (24.3%). The mean serum gonadotropin level was not different between patients with and without pituitary MRI abnormalities (P>0.05). Space-occupying lesions were not associated with low gonadotropin levels, type of amenorrhea, or presence of secondary sex characteristics. The frequency of space-occupying lesions was higher in patients with interrupted puberty (25.0%) than in patients who did not go through puberty (4.8%) or had a normal puberty (9.8%), but were not statistically significant (P>0.05). Small PG was associated with low gonadotropin levels and type of amenorrhea (P<0.05). CONCLUSION: Clinically significant space-occupying lesions were not associated with low gonadotropin levels, type of amenorrhea, or presence of secondary sex characteristics. However, the frequency of space-occupying lesions was higher in patients with interrupted puberty than in patients who did not go through puberty or who with normal puberty.

Clinical Characteristics of Odontogenic Cutaneous Fistulas

BACKGROUND: Odontogenic cutaneous fistula appears as dimpling or a nodule with purulent discharge, usually in the chin or jaw. Affected patients usually seek help from dermatologists or surgeons rather than from dentists. However, clinical symptoms of facial skin fistula without dental problems can lead to misdiagnosis. OBJECTIVE: The purpose of this study was to investigate the clinical characteristics of patients with odontogenic cutaneous fistulas. METHODS: This retrospective observational study was performed at Chungbuk National University Hospital by analyzing patients who visited from April 1994 to September 2014. Following clinical and radiographic examinations, the paths and origins of sinus fistulas were determined. Investigated factors were gender, age, morphology, location, originating tooth, time to evolution, recurrence, and treatment method. RESULTS: Thirty-three patients (22 males, 11 females; average age 49.2 years) were examined during the investigation period. Thirty-four fistulas were diagnosed as odontogenic cutaneous fistulas. The most common morphology was dimpling (n=14, 41.2%). The various locations observed were related to the originating tooth. The most common site was the mandibular body related to mandibular molars. The referral clinical diagnosis was of odontogenic origin in 6 cases (18.2%). The majority of patients had experienced recurrence after treatment in previous clinics that had failed to diagnose odontogenic cutaneous fistula. Surgical fistulectomy and/or tooth treatment were performed in all cases. All patients were followed-up for 1 year. None showed signs of recurrence. CONCLUSION: Extraoral and dental examinations are required to make a diagnosis of odontogenic cutaneous fistula. Thus, cooperation between dermatologists and dentists is essential.

Blood Triglycerides Levels and Dietary Carbohydrate Indices in Healthy Koreans / 예방의학회지

OBJECTIVES: Previous studies have obtained conflicting findings regarding possible associations between indices measuring carbohydrate intake and dyslipidemia, which is an established risk factor of coronary heart disease. In the present study, we examined cross-sectional associations between carbohydrate indices, including the dietary glycemic index (GI), glycemic load (GL), total amount of carbohydrates, and the percentage of energy from carbohydrates, and a range of blood lipid parameters. METHODS: This study included 1530 participants (554 men and 976 women) from 246 families within the Healthy Twin Study. We analyzed the associations using a generalized linear mixed model to control for familial relationships. RESULTS: Levels of the Apo B were inversely associated with dietary GI, GL, and the amount of carbohydrate intake for men, but these relationships were not significant when fat-adjusted values of the carbohydrate indices were used. Triglyceride levels were positively associated with dietary GI and GL in women, and this pattern was more notable in overweight participants (body mass index [BMI] ≥25 kg/m2). However, total, low-density lipoprotein and high-density lipoprotein cholesterol levels were not significantly related with carbohydrate intake overall. CONCLUSIONS: Of the blood lipid parameters we investigated, only triglyceride levels were positively related with dietary carbohydrate indices among women participants in the Healthy Twin Study, with an interactive role observed for BMI. However, these associations were not observed in men, suggesting that the association between blood lipid levels and carbohydrate intake depends on the type of lipid, specific carbohydrate indices, gender, and BMI.

Various autogenous fresh demineralized tooth forms for alveolar socket preservation in anterior tooth extraction sites: a series of 4 cases / 대한악안면성형재건외과학회지

The aim of this study was to evaluate the clinical relevance of autogenous fresh demineralized tooth (Auto-FDT) prepared at chairside immediately after extraction for socket preservation. Teeth were processed to graft materials in block, chip, or powder types immediately after extraction. Extraction sockets were filled with these materials and dental implants were installed immediately or after a delay. A panoramic radiograph and a conebeam CT were taken. In two cases, tissue samples were taken for histologic examination. Vertical and horizontal maintenance of alveolar sockets showed some variance depending on the Auto-FDT and barrier membrane types used. Radiographs showed good bony healing. Histologic sections showed that it guided good new bone formation and resorption pattern of the Auto-FDT. This case series shows that Auto-FDT prepared at chairside could be a good material for the preservation of extraction sockets. This study will suggest the possibility of recycling autogenous tooth after immediate extraction.

Impact of ENPP1 K121Q on Change of Insulin Resistance after Web-Based Intervention in Korean Men with Diabetes and Impaired Fasting Glucose

Ectoenzyme nucleotide pyrophosphate phosphodiesterase 1 (ENPP1) gene has been studied in relation to type 2 diabetes mellitus (T2DM) and insulin resistance (IR). We hypothesized that the difference in genotype may be one of the factors that affect the outcome of intervention. We genotyped 448 men with fasting glucose> or =5.6 mM/L, including 371 in subjects with K allele (KK) (69 control group [CG]; and 302 intervention group [IG]) and 77 in subjects with Q allele (KQ+QQ) (13 CG and 64 IG). The web-based intervention based on a lifestyle modification was delivered by e-mail once a month for 10 months. In the KK, IG demonstrated significantly decreased levels of fasting serum insulin (FSI) as compared to CG and homeostasis model of assessment of insulin resistance (HOMA-IR). In the KQ+QQ IG group, hemoglobin A1c (HbA1c), FSI and HOMA-IR were significantly decreased, and showed further reduction in the HOMA-IR than KQ+QQ CG. After analysis of covariance, K121Q did significantly influence the change of HbA1c in CG after appropriate adjustment. In a multivariate model, BMI change predicted HOMA-IR change (adjusted beta=0.801; P=0.022) in KK IG subjects with T2DM. ENPP1 K121Q did not influence the change in IR. However, individuals with T2DM carrying the K121 variant are very responsive to the effect of BMI reduction on HOMA-IR.

Comparison of health outcomes according to intervention compliance in male Korean workers with metabolic syndrome

This study examined how achievement of session goals contributes to outcomes of subjects after participation in a 12-week lifestyle intervention program in men with metabolic syndrome (MetS). Thirty office workers with MetS, aged 47.2 +/- 6.6 years, participated in this study, from March to July, 2011. The intervention program included face-to-face counseling five times during the 12-week period. Counselors and subjects designed session goals for each round. The average of the goal achievement rate was calculated based on compliance for each round. The subjects were divided into three groups according to their tertiles of achievement rate: Low-compliance group (LC, 70%). Anthropometry, biochemical index, and nutrient intake were examined at baseline and at the end of the 12-week intervention program. After the intervention, diastolic blood pressure (DBP) showed a significant decrease in the LC group, and waist circumference (WC) showed a significant decrease in the MC group. Systolic blood pressure (SBP), DBP, and low-density lipoprotein cholesterol (LDL) showed a significant decrease in the HI group. Changes in SBP and DBP were significantly lower in the HC group than in the MC group (p < 0.05, p < 0.01). Changes in LDL were significantly lower in the HC group than in the MC group (p < 0.05). Results for intake of total energy, protein, fat, and sodium, as well as rates of carbohydrate and fat intake, showed a significant decrease in all participants (p < 0.05). The change in fiber was significantly higher in the HC group than in the MC group (p < 0.05). The change of fruit serving size showed a significant increase in the HC group (p < 0.01). The number of risk factors for MetS showed a significant decrease in the LC and HC groups (p < 0.05), however, no significant mean differences were observed among the three groups. In conclusion, participation in this intervention program resulted in positive effects on risk factors for MetS, nutrient intake, and dietary habits, especially in the High-compliance group.

Epidermolysis Bullosa with Mouth Opening Limitation

Use of Serum Homocysteine to Predict Cardiovascular Disease in Korean Men with or without Metabolic Syndrome

The aim of this study was to examine whether serum homocysteine (Hcy) levels correlated with cardiovascular disease (CVD) depending on the presence or absence of metabolic syndrome (MetS) in Korean men. We conducted a case-control study, including 138 CVD and 290 non-CVD age-matched control subjects. The subjects were divided into four subgroups: 34 CVD/MetS, 104 CVD, 77 MetS, and 213 normal subgroups. The mean Hcy was significantly higher, whereas HDL and intake of vitamin B1 and B2 were lower in the CVD group (P < 0.05) than non-CVD group. When compared to the control group, subjects with CVD/MetS, CVD and MetS exhibited high Hcy levels, with the highest observed in the CVD/MetS subgroup (P < 0.001). Multivariate stepwise linear regression between CVD and markers of CVD showed Hcy significantly correlated with CVD (P < 0.05). To predict CVD based on Hcy, Hcy threshold of 11.72 microM in non-MetS subjects had an area under the curve (AUC) of 0.664 (95% CI 0.598-0.731). In MetS subjects, the AUC was 0.618 and Hcy threshold was 13.32 microM (95% CI 0.509-0.726). The results of our study show that the presence of MetS needs to be considered when using Hcy levels for predicting CVD.

Management of Proteus Syndrome with Craniofacial Hemihyperostosis: Case Report

The Effects of a Worksite On-line Health Education Program on Metabolic Syndrome Risk Factors and Nutrient Intakes of Male Workers

Worksite health promotion programs have been associated with reductions in health risks but are labor-intensive and costly to implement. Therefore, innovative strategies to provide a cost-effective approach to health education program are needed. The purpose of this study was to investigate the effects of a worksite on-line health education program by e-mail on metabolic syndrome risk factors and dietary intakes in male workers with metabolic syndrome. Anthropometric and biochemical parameters were measured and the nutrient intakes were assessed through FFQ. The diagnosis of metabolic syndrome was adapted from NCEP-ATP III with blood pressure, fasting blood glucose, triglyceride, HDL cholesterol, and Asia-Pacific definition with waist circumference. The education group consisted of 212 male workers and the non-education group of 236 age-matched male workers. The on-line health education program provided 10 sessions by e-mail. After a worksite on-line health education program, systolic blood pressure (p < 0.001), diastolic blood pressure (p < 0.001) and fasting blood glucose (p < 0.001) were significantly decreased and HDL cholesterol (p < 0.001) was significantly increased in the education group. Intakes of total energy (p < 0.05), carbohydrate (p < 0.05), sodium (p < 0.05) were significantly decreased in the education group, but there were no significant differences in dietary intakes in the non-education group after a worksite on-line health education program. The results indicate that online health education program by e-mail is effective for improving metabolic syndrome risk factors and dietary intakes in male workers and show potential for use in the working setting.

Comparison of Batch Assay and Random Assay Using Automatic Dispenser in Radioimmunoassay / 핵의학분자영상

PURPOSE: Radioimmunoassay (RIA) was usually performed by the batch assay. To improve the efficiency of RIA without increase of the cost and time, random assay could be a choice. We investigated the possibility of the random assay using automatic dispenser by assessing the agreement between batch assay and random assay. MATERIALS AND METHODS: The experiments were performed with four items; Triiodothyronine (T3), free thyroxine (fT4), Prostate specific antigen (PSA), Carcinoembryonic antigen (CEA). In each item, the sera of twenty patients, the standard, and the control samples were used. The measurements were done 4 times with 3 hour time intervals by random assay and batch assay. The coefficient of variation (CV) of the standard samples and patients' data in T3, fT4, PSA, and CEA were assessed. ICC (Intraclass correlation coefficient) and coefficient of correlation were measured to assessing the agreement between two methods. RESULTS: The CVs (%) of T3, fT4, PSA, and CEA measured by batch assay were 3.2+/-1.7%, 3.9+/-2.1%, 7.1+/-6.2%, 11.2+/-7.2%. The CVs by random assay were 2.1+/-1.7%, 4.8+/-3.1%, 3.6+/-4.8%, and 7.4+/-6.2%. The ICC between the batch assay and random assay were 0.9968 (T3), 0.9973 (fT4), 0.9996 (PSA), and 0.9901 (CEA). The coefficient of correlation between the batch assay and random assay were 0.9924(T3), 0.9974 (fT4), 0.9994 (PSA), and 0.9989 (CEA) (p<0.05). CONCLUSION: The results of random assay showed strong agreement with the batch assay in a day. These results suggest that random assay using automatic dispenser could be used in radioimmunoassay.

Preliminary Study on the Enhancement of Reconstruction Speed for Emission Computed Tomography Using Parallel Processing / 핵의학분자영상

PURPOSE: Conventional image reconstruction uses simplified physical models of projection. However, real physics, for example 3D reconstruction, takes too long time to process all the data in clinic and is unable in a common reconstruction machine because of the large memory for complex physical models. We suggest the realistic distributed memory model of fast-reconstruction using parallel processing on personal computers to enable large-scale technologies. MATERIALS AND METHODS: The preliminary tests for the possibility on virtual manchines and various performance test on commercial super computer, Tachyon were performed. Expectation maximization algorithm with common 2D projection and realistic 3D line of response were tested. Since the process time was getting slower (max 6 times) after a certain iteration, optimization for compiler was performed to maximize the efficiency of parallelization. RESULTS: Parallel processing of a program on multiple computers was available on Linux with MPICH and NFS. We verified that differences between parallel processed image and single processed image at the same iterations were under the significant digits of floating point number, about 6 bit. Double processors showed good efficiency (1.96 times) of parallel computing. Delay phenomenon was solved by vectorization method using SSE. CONCLUSION: Through the study, realistic parallel computing system in clinic was established to be able to reconstruct by plenty of memory using the realistic physical models which was impossible to simplify

A lipoma of the mouth floor : A case report

Lipoma is most common tumor that compromises 4% to 5% of all benign neoplasm, but in oral cavity it is uncommon. In oral cavity, lipoma presents painless, asymptomatic , slow growing, but sometimes it grows to larger size causing deformities, mastication and speech difficulties. While lipoma in commonly affects female patients (68-73%), oral lipoma appears more frequently in male patients. The majority of oral lipoma is seen after the age of forty (uncommon in children). Lipoma of oral cavity and maxillofacial region occurs most commonly in the parotid region, followed by the buccal mucosa, lip, tongue, palate, mouth floor, gingiva in order. A treatment of lesion is surgical excision with recurrence not expected. In this paper we present the case of a patient who has Lipoma in the mouth floor.

Apolipoprotein E Phenotypes and the Relationship Among Lipid Levels, Nutrient Intakes, Lifestyles and Risk Factors Between Subjects with and without Hyperlipidemic Risk

This study was performed to investigate Apolipoprotein E phenotypes and the relationship among lipid levels, nutrient intakes, lifestyles and risk factors between subjects with and without hyperlipidemic risk. The data were collected from 675 industrial male workers who had completed annual medical examination. Compared to the normal group, the hyperlipidemic risk group in Apo E3 and E4 had significantly higher BMI (p < 0.05) and showed significantly higher body fat (%), waist circumference and WHR in all types of Apo E (p < 0.05). In addition, the hyperlipidemic risk group had significantly higher total cholesterol, LDL-cholesterol, triglyceride and AI than the normal group in all types of Apo E (p < 0.05). Intakes of protein, calcium, phosphorus, iron, vitamin A, vitamin B1, vitamin B2, vitamin C and niacin in Apo E3 were significantly lower in the hyperlipidemic risk group than in the normal group (p < 0.05). In the logistic regression analysis, after adjustment for other factors, Apo E2 + E4, waist and WHR were the significant risk factors associated with hyperlipidemia, but protein intakes were associated with significantly lower risks of hyperlipidemia (p < 0.05). In conclusion, genetic factor (Apo E2 or Apo E4), anthropometric index and nutrient intake seem to influence hyperlidemic risk. Further studies and efforts will be needed to evaluate the independent relationships among hyperlipidemic risk factors.

Development and Testing of an Instrument to Measure Family's Emotional Response toward Physically Restrained Patients / 간호학회지

PURPOSE: This was a methodological research to develop an instrument to assess the emotional response of family members of physically restrained patients. METHODS: A primary instrument with 68 questions was developed based on literature review and semi-structured interviews with family members. A group of experts revised individual questions and removed 4 irrelevant questions. This secondary instrument, then, was tested with 199 family members of physically restrained patients in intensive care units of a university hospital. The validity and reliability of the instrument were tested by factor analysis. RESULTS: After item analysis, 3 questions with a correlation coefficient under .30 were discarded and the questions with a factor loading under .45 on Varimax Rotation were also removed. After factor analysis on the final 37 questions, 7 factors were identified; avoidance, shock, helplessness, grudge, depression, anxiousness, and acceptance. The total variance explained was 55.63%. The reliability of this instrument was 0.93 of Cronbach's alpha. CONCLUSION: This instrument was statistically reliable and valid to measure family's emotional response to physical restraints of the patients. This instrument can be useful in assessing the effects of nursing interventions for family members of restrained patients.